Victoria Goldman takes a look at current guidance on breastfeeding and the introduction of complementary feeding…

A new government-led campaign, launched in February 2023, is supporting parents to safely move their babies from breastfeeding (or infant formula milks) to solid foods at the appropriate time. A survey by Censuswide found that 46 per cent of parents believed that solid foods should be introduced at around five months or earlier.

Half of parents were also confused about how much to feed their baby and at which age to start weaning, with many saying they had received conflicting advice.

The NHS follows World Health Organisation (WHO) guidance, which recommends that babies are breastfed exclusively (where possible) for the first six months of their life. Breastfeeding should then be continued for at least the first two years, with complementary foods being introduced when babies reach six months.

However, many women struggle to exclusively breastfeed for this length of time, and the UK has one of the lowest rates of breastfeeding in Europe.

In April 2023, research led by the University of Glasgow and published in PLOS Medicine revealed that a shorter duration of non-exclusive breastfeeding may still be beneficial for babies. The study looked at the health and educational data for 191,745 children born in Scotland from 2004 onwards.

It found that babies who are exclusively breastfed or fed a mix of formula and breastmilk for the first six to eight weeks of life are at lower risk of having special educational needs and learning disabilities.

“We know that many women struggle to exclusively breastfeed for the full six months recommended by WHO,” says Dr Michael Fleming, who led the study at the University of Glasgow’s School of Health and Wellbeing.

“However, our study provides evidence that a shorter duration of non-exclusive breastfeeding could nonetheless be beneficial with regards to a child’s learning development.”

Colic advice

Global marketing director of Crosscare Sharon Skelton said pharmacies “are a typical first port of call for parents seeking advice” about colic.

“With over 20 years of experience, we at Colief know how distressing it can be for parents when their baby has colic,” she said.

“A cry diary is a useful tool to offer parents as it will help parents identify times when their baby’s colic is at its worst. They may be able to find a pattern associated with what triggers the colicky episode, allowing them to understand better how to ease the symptoms.

“A pharmacy can also offer advice on OTC and non-pharmacological treatments.”

Breastfeeding benefits

According to the State of Child Health report by the RCPCH, published in March 2020, breastfeeding has many benefits, including a reduced risk of digestive problems in babies and respiratory infections in babies and children. There is also growing evidence that breastfeeding protects against the risk of becoming overweight or obese into adulthood.

The Scientific Advisory Committee on Nutrition (SACN) report on feeding in the first year of life, published in July 2018, states that breastfeeding has an important role in the development of a baby’s immune system and may reduce hospital admission for infectious illnesses in babies. Breastfeeding also seems to reduce the risk of tooth decay in babies.

A series paper published in The Lancet in February 2023 pointed out that breastfeeding’s benefits involve more than simply transferring breast milk from the mother to the baby – suckling directly from the breast may be important for babies’ facial development and self-regulation of energy intake, while skin-to-skin contact may help to improve babies’ temperature control and metabolism.

In mothers, breastfeeding is associated with greater weight loss after the birth and lower body mass index (BMI) in the longer term. According to The Lancet in February 2023: Breastfeeding also helps to protect the mother against chronic diseases, including breast and ovarian cancers, type 2 diabetes, and cardiovascular disease.”

Breastfeeding rates

Breastfeeding initiation rates in the UK are lower than in many comparable high-income countries and have shown minimal improvement in recent years. Mothers in the most deprived areas have consistently lower rates of initiating and continuing breastfeeding compared to those in the least deprived areas.

The government’s statistics on Breastfeeding at 6 to 8 weeks after birth: annual data 2020 to 2021 (published in November 2021) revealed that the aggregate breastfeeding rate for England for 2020/2021 was 47.6 percent.

Many factors lead mothers to stop breastfeeding early on. A survey conducted by Public Health England in 2016 highlighted potential barriers including uncertainty with how to breastfeed, what to consider when breastfeeding, and embarrassment around breastfeeding in public.

According to The Lancet article in February 2023, parents and health professionals also frequently misinterpret typical, unsettled baby behaviours (such as crying) as signs of milk insufficiency or inadequacy, leading parents to prematurely switch from breastmilk to infant formula.

The July 2018 SACN report stresses that infant formula (based on either cows’ or goats’ milk) is the only suitable alternative to breast milk for babies under 12 months, and breast milk, infant formula and water should be the only drinks offered after six months. Soya-based formula should be given to babies only on medical advice. Unmodified cows’ milk shouldn’t be given as a main drink to babies under 12 months because its iron content is low.

Improving breastfeeding rates

According to the RCPCH, while breastfeeding is a natural process, many parents require support, knowledge and education to continue.

“Having listened to the issues of feeding mothers, I’ve realised that many problems could be resolved quite simply,” says Carol Lawless, specialist tongue-tie practitioner, midwife and lactation consultant.

“It would be amazing if as a professional I could be there to simply reassure these parents, offer the encouragement the NHS is sadly not equipped for due to budget cuts. Many parents stop when they are so close. Other countries have much better feeding rates as it is very much part of their culture.”

According to the RCPCH’s State of Child Health report, there are several ways in which healthcare professionals could encourage the uptake of breastfeeding and encourage women to breastfeed for longer.

1. Breastfeeding advice. Be aware of specialist and local breastfeeding services to signpost mothers effectively. Community pharmacists are well-placed to keep a stock of breastfeeding supplies (e.g. pads, pumps) and suitable products to deal with any breastfeeding problems (e.g. sore nipples).
2. Make every contact count. Take the opportunity to proactively explore and promote breastfeeding practices in a sensitive manner. Community pharmacists could ask new parents if they are experiencing any problems with infant feeding (not just breastfeeding) and whether they need any help or support.
3. Maintain a respectful approach. If a woman chooses not to breastfeed after being given appropriate information, advice and support, her choice must be respected by healthcare professionals.